Final DSA following removal of the stent-retriever demonstrating reperfusion of the previously occluded MCA. TICI 2C angiographic result (some underfilling of small distal parietal MCA cortical branches).

CT brain 24 hours later

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Axial non-contrast

The previously demonstrated MCA M1 thrombus has been removed. Expected maturation of previously demonstrated right insular cortex and lentiform nucleus infarction. No new infarction demonstrated. No hemorrhage.

2 case question available

Q: What are the clinically significant findings on the non contrast CT brain (in addition to the hyperdense MCA M1)?
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A: 1. There is no intracranial haemorrhage.
2. Only a small volume of established infarction is present. The hypoattenuation of the insular cortex and the lentiform nucleus equates to an ASPECTS score of 8.

Q: If you are working in a mechanical thrombectomy hospital and are reviewing the CT and CT angiogram at the time of scanning (paying attention to the clinical history and time course) - what is the role of CT perfusion in this particular case?
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A: None.
At 90 minutes post symptom onset with an acute MCA M1 occlusion and only a small volume of established infarction on CT (ASPECTS 8) there is no potential finding on CT perfusion that changes management. This patient should proceed to mechanical thrombectomy without delay.

Case Discussion

Good demonstration of hyper-acute non-contrast CT findings in MCA embolic stroke.DSA images demonstrating the MCA M1 clot and its removal with mechanical thrombectomy.